Parasomnias in children

Last reviewed: 29 Oct 2022
Last updated: 10 Aug 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • disturbed cognition during event (confusional arousals, sleep terrors, sleepwalking)
  • vigorous activity or violent behaviour (confusional arousals, sleepwalking, sleep terrors, and rapid eye movement sleep behaviour disorder [RBD])
  • episodes of inability to move (isolated recurrent sleep paralysis)
  • autonomic hyperactivity during event (sleep terrors)
  • amnesia
  • normal physical examination between episodes
More key diagnostic factors

Other diagnostic factors

  • abnormal demeanour and facial expression (confusional arousals, sleepwalking, sleep terrors)
  • evidence of injuries
Other diagnostic factors

Risk factors

  • family history of non-rapid eye movement (NREM) parasomnias (confusional arousals, sleepwalking, sleep terrors)
  • presence of HLA gene DQB1*05 and *04 alleles (sleepwalking)
  • medications or alcohol
  • history of psychiatric disorder
  • fever
  • acute sleep deprivation or irregular sleep-wake schedule disorder
  • emotional stress and traumatic life events
  • forced awakenings
  • untreated comorbid sleep disorders
  • premenstrual state (in adolescent girls)
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical examination
  • polysomnography (rapid eye movement sleep behaviour disorder)
More 1st investigations to order

Investigations to consider

  • polysomnography (confusional arousals)
  • polysomnography (sleepwalking)
  • polysomnography (sleep terrors)
  • polysomnography (nightmare disorder)
  • polysomnography (all other parasomnias)
  • polysomnography with expanded electroencephalogram (EEG) video recording
  • urine drug screen
More investigations to consider

Treatment algorithm

ONGOING

confusional arousals

sleepwalking

sleep terrors

nightmares

isolated recurrent sleep paralysis

rapid eye movement sleep behaviour disorder

Contributors

Authors

Shalini Paruthi, MD

Co-Medical Director, Sleep Medicine and Research Center

St. Luke's Hospital

Adjunct Associate Professor

Department of Pediatrics

Saint Louis University School of Medicine

St Louis

MO

Disclosures

SP receives royalties from UpToDate for writing two topics: diagnosis and management of pediatric obstructive sleep apnea. SP is a board member of the Restless Legs Syndrome Foundation.

Acknowledgements

Dr Shalini Paruthi would like to gratefully acknowledge Dr Raman Malhotra and Dr Alon Y. Avidan, previous contributors to this topic.

Disclosures

AYA has been paid honorarium speaking fees by the American Academy of Sleep Medicine, the American Academy of Neurology, the American College of Chest Physicians, Sepracor Inc, Cephalon Inc, and Pfizer Pharmaceuticals.

Peer reviewers

Paul Gringras, MB, ChB, MSc, MRCPCH

Consultant in Paediatric Neurodisability

Evelina Children's Hospital

St Thomas' Hospital

London

UK

Disclosures

PG is lead applicant on the ongoing MENDS trial, which is concerned with the use of melatonin in children with neurodevelopmental disorders and impaired sleep.

Paul Montgomery, MSc, DipSW, DPhil

Reader in Psycho-Social Intervention

Centre for Evidence Based Intervention

Barnett House

University of Oxford

Oxford

UK

Disclosures

PM has received funding greater than 6 figures USD from the Swedish Board of Health and Welfare, Martek Biosciences, Danish Social Research Institute, UK Department of Health, UK Health Technology Assessment Programme. PM declares that he has no competing interests.

Lynn A. D'Andrea, MD

Associate Professor of Pediatrics

Chief

Division of Pulmonary and Sleep Medicine

Department of Pediatrics

Medical College of Wisconsin

Medical Director

Pulmonary Clinic

Children's Hospital of Wisconsin

Milwaukee

WI

Disclosures

LAD declares that she has no competing interests.

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